Section 1: Personal Details

1. What is your age group?

2. Who are you completing this questionnaire for?


For the following questions, "the individual" refers to the person this questionnaire is being completed for.
Section 2: Personal Health History

3. Has the individual or their child ever been diagnosed with any of the following conditions?

(Select all that apply)

4. Has the individual or their child experienced symptoms that remain unexplained despite medical investigations?

5. Has the individual consulted multiple specialists without receiving a clear diagnosis?


Section 3: Family History

6. Does anyone in the family have any of the below conditions?

(Select all that apply)

7. Are there multiple family members with the same medical condition?


Section 4: Pregnancy & Reproductive Health

8. Is the individual planning a pregnancy or is currently pregnant?

9. Has the individual experienced any of the following?

(Select all that apply)

Section 5: Interest in Genomic Medicine

10. What would you like to learn more about?

(Multiple selections allowed)

11. Would you like a genomic medicine specialist to contact you?

Introducing Our Genetic Counsellors

sunway Ms Tiong Shing Yiing

Ms Tiong Shing Yiing

Genetic Counsellor

Ms Rahimah Zahidah Mohd Rais Sunway

Ms Rahimah Zahidah Mohd Rais

Genetic Counsellor

Sunway Ms Yoon Sook Yee

Ms Yoon Sook Yee

Visiting Genetic Counsellor

Book an Appointment

Location

Health Screening Centre /
Genomic Medicine Centre,
8th Floor, Tower D

Address

Sunway Medical Centre
No. 5 Jalan Lagoon Selatan,
Bandar Sunway, 47500
Selangor, Malaysia.

Contact Us

Email: [email protected]
Call / WhatsApp: +6019-384 1268 (Careline)

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